Policyholder: Thompson Technologies Voluntary Short Term Disability (STD) Benefit Summary Effective Date: 09/01/2015 This chart provides you a brief summary of the key benefits of the short-term disability coverage available from Principal Life Insurance Company. Following the chart, you will find additional information to answer questions you may have. For a complete list of all your short-term disability coverage benefits and restrictions, please refer to your booklet or contact your employer. Job Class Eligible Members Eligibility ALL MEMBERS All active, full time employees (except seasonal, temporary, or contract workers) who work at least 30 hours per week Benefits Payable Primary Weekly Benefit 60% of your predisability earnings up to $1,000 Benefit Amount Primary Weekly Benefit less other income sources Definition of Earnings Base wage Elimination Period Benefit Payment Period Maternity Rehabilitation Incentive Benefit Pre-Existing Conditions Other Limitations Benefit Qualification Benefits begin on the 15th day for accident and 15th day for sickness Up to 11 weeks after the elimination period is satisfied Treated the same as any other disability Additional Benefits 5% increase in the primary weekly benefit Limitations & Exclusions 12 months prior/12 months insured There are additional limitations to your coverage. A complete list is included in your booklet. 04251410172-9 1 of 4 09/2014
VOLUNTARY SHORT-TERM DISABILITY Understanding Your Short-Term Disability Benefits Am I Eligible For Coverage? To be eligible for coverage, you must qualify as an eligible member and be considered actively at work. You will be considered actively at work if you are able and available for active performance of all of your regular duties. Short-term absence because of a regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal time off is considered active work provided you are able and available for active performance of all of your regular duties and were working the day immediately prior to the date of your absence. How Do I Qualify For Benefits? 1) Meet the Definition of Disability. Disabilities must be solely and directly caused by sickness, injury, or pregnancy. During the elimination period and the benefit payment period, one of these situations must apply: You cannot perform the majority of the substantial and material duties of your own job. You are performing the duties of your own job on a modified basis and lose at least 20% of the income you earned before becoming disabled. You are performing the duties of any other job and lose at least 20% of the income you earned before becoming disabled. 2) Satisfy the Elimination Period. The amount of time you must be disabled before receiving benefits is called the elimination period. Benefits begin on the 15th day when due to injury and begin on the 15th day when due to sickness. The elimination period can be satisfied with days of total or partial disability. How Much Weekly Benefit Will I Receive? Your benefits will be determined by using your base wage. The benefit payment period is the length of time you will receive benefits for a qualifying disability after the elimination period is satisfied. When you are unable to work in any capacity during the benefit payment period, your primary weekly benefit is equal to 60% of your predisability earnings, up to $1,000. Your primary weekly benefit less income from other sources is the benefit amount you will receive. Your benefit amount will never be less than the $15 minimum benefit. 04251410172-9 2 of 4 09/2014
VOLUNTARY SHORT-TERM DISABILITY Benefits if Working If you are able to work while disabled, you may still be eligible to receive a disability benefit. If you are working during the benefit payment period, your benefit amount is the lesser of: Your primary weekly benefit, less income from other sources, multiplied by your income loss percentage; or 100% of your predisability earnings, less income from other sources, less current earnings. You must work to your full medical and vocational capacity. If you choose not to, your benefits will be paid as if you are working to your full capacity. Income you receive from other sources can be deducted from your primary weekly benefit. For a complete list of other sources, please refer to your booklet. Other sources may include: All retirement or disability benefits that you and your dependents receive or could have received from Social Security or other government agencies/ Salary continuance, personal time off or sick pay / Workers Compensation benefits / Income from state disability plans / Disability or retirement benefits paid by pension plans sponsored by the policyholder / Income received from no-fault auto laws / Severance pay / All payments for the month that the member receives under state unemployment laws. How Long Will I Receive My Benefits? You are eligible to receive short-term disability benefits for 11 weeks after the elimination period is satisfied. Your disability benefits will end when you: Recover / Cease to be under the regular and appropriate care of a physician / Fail to provide any required proof of disability / Fail to submit to a required medical examination / Fail to report income from other sources, or any other required earnings information / Fail to pursue Social Security disability benefits or Workers Compensation benefits / Die. If you recover and return to work for 30 days or less during the benefit payment period and then again become disabled from the same or related cause, you are not required to satisfy a new elimination period. What Additional Benefits Are Included? Rehabilitation Plan Rehabilitation Incentive Benefit Mandatory Rehabilitation While disabled, you may qualify to participate in a rehabilitation plan. Our rehabilitation staff works with you, your physician(s) and your employer to create an individual rehabilitation plan to assist you in returning to work. If you are not disabled, but have a condition that could prevent you from performing the substantial and material duties of your own job, preventive rehabilitation services may be offered. The Rehabilitation Incentive Benefit can increase the primary weekly benefit by 5% if you become totally disabled and participate in and satisfy the requirements of an individual rehabilitation plan. Your Mandatory Rehabilitation provision indicates that, if appropriate, you may be required to participate in an individual rehabilitation plan. 04251410172-9 3 of 4 09/2014
VOLUNTARY SHORT-TERM DISABILITY What Are The Restrictions Of My Coverage? This Benefit Summary is a summary only. For a complete list of benefit restrictions, please refer to your booklet. Pre-existing Conditions A pre-existing condition is an injury or sickness (including pregnancy) and all related conditions and complications, in the 12 months prior to your effective date under this policy, for which you: Received medical treatment, consultation, care or service; or Were prescribed or took prescription medications Benefits will be payable during the pre-existing investigation for up to 6 weeks following the date of disability. Benefits will not be paid beyond the date six weeks following the date of disability for disabilities resulting from pre-existing conditions unless, when you become disabled, you have been actively at work for one full day after being covered under the policy for 12 consecutive months. No benefits will be paid for any disability that is caused by, a complication of, or resulting from the same pre-existing condition that you had previously received benefits for. Pre-existing condition limitations also apply to benefit increases due to: Policy amendments Changes in earnings of 25% or greater WE LL GIVE YOU AN EDGE Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com This is a summary of life coverage underwritten by or with administrative services provided by Principal Life Insurance Company. This benefit summary is for administrative purposes and is not a complete statement of benefits and restrictions. You ll receive a benefit booklet with details about your coverage. If there is a discrepancy between this summary and your benefit booklet, the benefit booklet prevails. GP 55813-4 08/2012 2012 Principal Financial Services, Inc. 04251410172-9 4 of 4 09/2014
Policyholder: Thompson Technologies Voluntary Long Term Disability (LTD) Benefit Summary Effective Date: 09/01/2015 This chart provides you a brief summary of the key benefits of the long-term disability coverage available from Principal Life Insurance Company. Following the chart, you will find additional information to answer questions you may have. For a complete list of all your long-term disability coverage benefits and restrictions, please refer to your booklet or contact your employer. Job Class Eligible Members ALL MEMBERS Eligibility All active, full time employees (except seasonal, temporary, or contract workers) who work at least 30 hours per week Benefits Payable Primary Monthly Benefit 60% of your predisability earnings up to $6,000. Benefit Amount Definition of Earnings Elimination Period Own Occupation Period Maximum Benefit Payment Period Rehabilitation Incentive Benefit Survivor Benefit Pre-Existing Conditions Other Limitations Primary monthly benefit less other income sources Base wage 90 days 2 years To age 65 Benefit Qualification Additional Benefits 5% increase in the monthly benefit percentage Three times your primary monthly benefit to your survivor. Limitations & Exclusions 6 months prior/12 months treatment free/24 months insured There are additional limitations to your coverage. A complete list is included in your booklet. 04251410172-9 1 of 5 09/2014
VOLUNTARY LONG-TERM DISABILITY Understanding Your Long-Term Disability (LTD) Benefits Am I Eligible For Coverage? To be eligible for coverage, you must qualify as an eligible member and be considered actively at work. You will be considered actively at work if you are able and available for active performance of all of your regular duties. Short term absence because of a regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal time off is considered active work provided you are able and available for active performance of all of your regular duties and were working the day immediately prior to the date of your absence. How Do I Qualify For Benefits? 1) Meet the Definition of Disability. Disabilities must be solely and directly caused by injury or sickness (including pregnancy). During the elimination period and the own occupation period, one of these situations must apply: After completing the own occupation period, one of these situations apply: You cannot perform the majority of the substantial and material duties of your own occupation. You are performing the duties of your own occupation on a modified basis or any occupation and are unable to earn more than 80% of your indexed predisability earnings. You cannot perform the majority of the substantial and material duties of any gainful occupation for which you are or may reasonably become qualified based on education, training, or experience. You are performing the substantial and material duties of your own occupation or any occupation on a modified basis and are unable to earn more than 60% of your indexed predisability earnings. 2) Satisfy the Elimination Period. The amount of time you must be disabled before receiving benefits is called the elimination period. Long-Term Disability benefits begin after you have been disabled for 90 days. The elimination period can be satisfied with days of total or partial disability. If you recover and return to work during the elimination period and become disabled again, you may not have to satisfy a new elimination period. If you become disabled again, your elimination period will pick up at the point where it was left off when you recovered. You have a period twice as long as the elimination period to satisfy the required number of days of disability. How Much Monthly Benefit Will I Receive? Your benefits will be determined based on your Base wage. 04251410172-9 2 of 5 09/2014
VOLUNTARY LONG-TERM DISABILITY When you are unable to work in any capacity during the benefit payment period, your monthly benefit equals your primary monthly benefit, less income from other sources. Your primary monthly benefit is equal to 60% of your predisability earnings, but will not exceed $6,000. Your monthly benefit will not be less than the minimum monthly benefit of $50. Benefits if Working If you are able to work while disabled, you may still be eligible to receive a disability benefit. If you are working during the benefit payment period, your monthly benefit for the 12 month work incentive period is the lesser of: 100% of the indexed earnings you received before becoming disabled, less income from other sources, less current earnings; or Your primary monthly benefit, less income from other sources. After the work incentive period, your monthly benefit equals your primary monthly benefit, less income from other sources, less 50% of current earnings. You must work to your full medical and vocational capacity. If you choose not to, your benefits will be paid as if you are working to your full capacity. Income you receive from other sources can be deducted from your primary monthly benefit. Other sources include: All retirement or disability benefits that you and your dependents receive, or could have received, from Social Security, or other government agencies /Salary continuance, personal time off or sick pay / Workers Compensation benefits / Income from state disability plans / Payments from policies that provide coverage for time away from work, if paid in part by or deducted from payroll by the policyholder / Income from other group disability coverage policies / Disability or retirement benefits paid by pension plans sponsored by the policyholder / Income received from no-fault auto laws / Renewal commissions received from the policyholder / Severance pay / All payments for the month that the member receives under state unemployment laws / Any income you receive for services rendered prior to your Date of Disability will not be considered Other Income Sources. How Long Will I Receive My Benefits? The benefit payment period is the length of time you'll receive benefits for a qualifying disability after the elimination period is satisfied. Your age at the time disability occurs determines the length of time you are eligible to receive disability benefits. Age Disability Occurs Under Age 62 Age 62 Age 63 Age 64 Age 65 Benefits are Payable: Until the later of the date you reach age 65 or 42 months 42 months 36 months 30 months 24 months 04251410172-9 3 of 5 09/2014
VOLUNTARY LONG-TERM DISABILITY Age Disability Occurs (continued) Age 66 Age 67 Age 68 Age 69 and over Benefits are Payable (continued) 21 months 18 months 15 months 12 months Your disability benefits will end when you: Recover / Cease to be under the regular and appropriate care of a physician / Fail to provide any required proof of disability / Fail to submit to a required medical examination / Fail to report income from other sources, or any other required earnings information / Fail to pursue Social Security disability benefits or Workers' Compensation benefits / Die. If you recover and return to work for six months or less during the benefit payment period and then again become disabled from the same or related cause, you are not required to complete a new elimination period. What Additional Benefits Are Included? Work Incentive Benefit Survivor Benefit Rehabilitation Plan Rehabilitation Incentive Benefit Mandatory Rehabilitation The Work Incentive Benefit is paid to you if you are disabled and you return to work on a limited or part-time basis. To receive benefits, you must be working. The Work Incentive Benefit equals the primary monthly benefit with no offset for work earnings unless the combination of work earnings, disability benefits and other income sources exceeds 100% of your predisability earnings. If this occurs, the Work Incentive Benefit will be reduced by the amount in excess of 100% of your predisability earnings. The Survivor Benefit is a lump sum payment issued to your survivors, should you die while receiving disability benefits. The benefit payment is equal to three times your primary monthly benefit. While disabled, you may qualify to participate in a Rehabilitation Plan. Our rehabilitation staff works with you, your physician(s) and your employer to create an individual rehabilitation plan to assist you in returning to work. If you are not disabled, but have a condition that could prevent you from performing the substantial and material duties of your own occupation, preventive rehabilitation services may be offered. The Rehabilitation Incentive Benefit can increase the benefit percentage by 5% if you become totally disabled and participate in and satisfy the requirements of an individual rehabilitation plan. The Mandatory Rehabilitation provision indicates that, if appropriate, you may be required to participate in an individual rehabilitation plan. Any expenses associated with the rehabilitation plan will be paid for by Principal Life. What Are The Restrictions Of My Coverage? This Benefit Summary is a summary only. For a complete list of benefit restrictions, please refer to your booklet. Preexisting Conditions A preexisting condition is an injury or sickness (including pregnancy) and all related conditions and complications, in the six months prior to your effective date under this policy, for which you: Received medical treatment, consultation, care or service; or 04251410172-9 4 of 5 09/2014
VOLUNTARY LONG-TERM DISABILITY Preexisting Conditions Were prescribed or took prescription medications Benefits will not be paid for disabilities resulting from preexisting conditions unless, when you become disabled, you have been actively at work for one full day after completing the earlier of: 12 consecutive months of coverage under the policy in which you received no treatment, including prescription medication, for the disabling condition; or 24 consecutive months of coverage under the policy. Treatment of Mental Health Conditions, Drug and Alcohol Abuse Conditions and Special Conditions Preexisting condition exclusions also apply to benefit increases due to policy amendments and changes in earnings of 25% or greater. A disability is considered due to alcohol, drug or chemical abuse, dependency or addiction or a mental health condition or a special condition if the disability is caused by one of these condition(s) and not by other disabling conditions. Maximum benefit payment periods for: Mental health conditions 24 months Alcohol, drug or chemical abuse conditions 24 months Special conditions 24 months The benefit payment period listed above is a lifetime maximum for all periods of disability. All disabilities from conditions with the same maximum benefit payment period contribute towards one lifetime maximum. However, if at the end of the benefit payment period, you are confined in a hospital or any other type of facility providing treatment for any of these conditions, the benefit payment period may be extended to include the time period you are confined for treatment. Special conditions are considered to be Thoracic outlet syndrome / Headaches, such as functional, migraine, organic, sinus and tension / Chronic fatigue syndrome / Fibromyalgia/ Temporomandibular joint (TMJ) / Cumulative trauma disorder, overuse syndrome, or repetitive stress disorder including carpal tunnel and ulnar tunnel syndrome / Environmental allergies and multiple chemical sensitivity / Musculoskeletal and connective tissue disorders of the neck and back, including any disease or disorder of the cervical, thoracic and lumbosacral back and surrounding soft tissue, including sprains and strains of joints and adjacent muscles. WE LL GIVE YOU AN EDGE Principal Life Insurance Company, Des Moines, Iowa 50392-0002, www.principal.com This is a summary of life coverage underwritten by or with administrative services provided by Principal Life Insurance Company. This benefit summary is for administrative purposes and is not a complete statement of benefits and restrictions. You ll receive a benefit booklet with details about your coverage. If there is a discrepancy between this summary and your benefit booklet, the benefit booklet prevails. GP 55672-9 05/2013 2013 Principal Financial Services, Inc. 04251410172-9 5 of 5 09/2014